Fifty-sixth annual meeting of the American association of physicists in medicine
SU-E-T-420: Impact of Different Prescription Isodose Lines On Plan Quality for Brain Metastases Using Multiplan System
With the sequential optimization algorithm in MultiPlan system, clinical objectives (homogeneity, PTV coverage, conformity, normal tissue protection) can be optimized in sequence. However, the prescription isodose line (RxIDL) varies widely among institutions, which can influence the optimized dose distribution. The aim of this study is to investigate the impact of different prescription isodose lines on plan quality for the treatment of brain metastases using CyberKnife Multiplan system.
Ten patients with multiple metastases were selected for this study. Four plans were generated for each patient such that 100% of the target volume receives the prescribed dose of 18 Gy, which was 50%, 60%, 70%, and 80% prescription Isodose line, separately. The prescription isodose was calculated as the ratio of the prescription dose and the maximum dose in target volume. The dosimetric parameters, including PTV coverage, conformity index (CI), gradient index (GI) and the volume covered by 12 Gy (V12Gy) were analyzed. The plan Monitor Units (MU) and treatment time were also compared.
All plans can provide the same target coverage (100%) and similar conformity index (1.26, 1.30, 1.32, and 1.29 on average for 80%, 70%, 60%, and 50% RxIDL plans, separately); there was no difference in critical structure dose. The 50% RxIDL plans have much lower GI (4.21±1.79 for 50% and 5.56±2.92 for 80% RxIDL plans) and V12Gy (13.36±10.31cc for 50% and 15.87±11.85cc for 80% RxIDL plans). The variation in estimated treatment delivery time was insignificant.
The dose falloff is much faster for the lower RxIDL plans in terms of GI and V12Gy. For 50% RxIDL plans, the average V12Gy decreases by 16% compared to 80% RxIDL plans, which indicates that the normal tissue can be better protected by decreasing the prescription Isodose line.